FFinalistSouthampton · 2027
Ophthalmology
AKT · Ophthalmology/Lids & surface

Viral conjunctivitis

Adenoviral conjunctivitis (highly contagious; HSV is a sight-threatening exception)

Overview

Highly contagious adenoviral conjunctivitis, usually following a URTI. Watery discharge, follicular reaction and a tender preauricular node. Self-limiting over 1–2 weeks; no antibiotic. The key exception is herpetic (HSV) infection, which must not be steroided or missed.

Recognise

  • Bilateral (often sequential) red eyes with WATERY discharge and a gritty/burning feel
  • Tender preauricular lymph node; follicles on the tarsal conjunctiva
  • Recent URTI/contact; very contagious (epidemic keratoconjunctivitis can reduce vision via subepithelial infiltrates)

Red flags

  • Dendritic ulcer on fluorescein, vesicular lid rash, or marked photophobia/visual loss → HSV — refer same-day, do NOT give topical steroids
  • Pseudomembrane or significant corneal infiltrates → ophthalmology

Differentials & how to tell them apart

Bacterial conjunctivitispurulent (not watery) discharge, no preauricular node
HSV keratoconjunctivitisdendritic ulcer, reduced corneal sensation, vesicles — sight-threatening
Allergic conjunctivitisitch-dominant, bilateral, atopic, no preauricular node
Viral (adenoviral) conjunctivitis — watery red eye

Viral (adenoviral) conjunctivitis — watery red eye

Joyhill09 / CC BY-SA 3.0 — Wikimedia Commons

Investigations

Clinical. Viral PCR swab (adenovirus/HSV) if recurrent or diagnostic doubt. Fluorescein to exclude a dendrite.

Management

Supportive (lubricants, hygiene); avoid antibiotics and avoid steroids

  1. 1Reassure (self-limiting 1–2 weeks). Strict hygiene — it is very contagious (separate towels, hand-washing, may be infectious up to ~14 days). Cool compresses and lubricants.Gate: If a DENDRITE on fluorescein, vesicles or reduced vision → HSV: refer same-day and do NOT prescribe topical steroids
  2. 2Persistent >7–10 days, pseudomembrane, or vision-reducing infiltrates → ophthalmology.
Lubricants / cool compresses — symptomatic relief; no antibiotic needed
Avoid topical steroids in primary care — can dramatically worsen undiagnosed HSV

Key points

Watery + preauricular node + URTI = adenovirus. Always fluorescein to exclude the herpetic dendrite before anyone reaches for steroids.

Monitor & prognosis

Resolution over 1–2 weeks; safety-net for visual change.

Self-limiting; EKC infiltrates can linger.

Source: NICE CKS Conjunctivitis – infective